Prognosis of rectal neuroendocrine tumors after endoscopic resection: a single-center retrospective study

Yue Zheng; Kehang Guo; Ruijie Zeng; Zhendao Chen; Wanwei Liu; Xiaoguang Zhang; Weimin Liang; Jianhua Liu; Hao Chen; Weihong Sha

doi:10.21037/jgo-21-391

Prognosis of rectal neuroendocrine tumors after endoscopic resection: a single-center retrospective study

J Gastrointest Oncol. 2021 Dec;12(6):2763-2774. doi: 10.21037/jgo-21-391.

Authors

Yue Zheng^#¹, Kehang Guo^#^{1

2}, Ruijie Zeng^#^{1

3}, Zhendao Chen^#⁴, Wanwei Liu¹, Xiaoguang Zhang¹, Weimin Liang¹, Jianhua Liu⁵, Hao Chen¹, Weihong Sha¹

Affiliations

¹ Department of Gastroenterology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² School of Medicine, South China University of Technology, Guangzhou, China.
³ Shantou University Medical College, Shantou, China.
⁴ Department of Gastroenterology, Huazhou People's Hospital, Maoming, China.
⁵ Department of Oncology, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

^# Contributed equally.

Abstract

Background: The efficacy of endoscopic resection in patients with rectal neuroendocrine tumors (NETs) which are less than 20 mm in diameter remains unclear. This study aimed to investigate the efficacy and outcomes of different types of endoscopic resection in patients with NETs.

Methods: We performed a retrospective analysis and follow-up on 98 patients who underwent endoscopic resection for rectal NETs between August 2010 and October 2019 at Guangdong Provincial People's Hospital, China. The lesions were preoperatively classified according to their endoscopic morphology and measured by endoscopic ultrasound. Patients were divided into modified endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) groups depending on the endoscopic treatment they received. The en bloc resection rate, histopathological complete resection rate, and the complication rate of the 2 groups were evaluated after the operation. The risk factors for incomplete resection were also analyzed.

Results: The average diameter of the 98 NETs was 6.29±2.90 mm (range, 2-15 mm). The en bloc resection rate of the modified EMR and ESD treatment groups was 97.2% (35/36) and 100% (62/62), respectively. The histopathological complete resection rate was 86.1% (31/36) and 87.1% (54/62), respectively. No tumor recurrence or tumor-related death occurred. There were no statistically significant differences in the rate of histopathological complete resection, perforation, or delayed hemorrhage between the 2 groups (P>0.05). Multivariate analysis demonstrated that the depth of tumor invasion (P=0.007) and tumor diameter (P<0.001) were independent risk factors for histopathological complete resection.

Conclusions: Modified EMR and ESD are safe and effective endoscopic approaches for the resection of rectal NETs ≤15 mm in diameter. Endoscopic resection requires a comprehensive preoperative evaluation of risk factors including the depth of tumor invasion and tumor diameter.

Keywords: Rectal neuroendocrine tumor; efficacy; endoscopic resection; safety.